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Workers' Compensation


Workers’ Compensation Insurance Benefits are designed to guarantee medical care for injured workers and to help pay for lost wages caused by the injury if the employee is unable to work and is temporarily or permanently disabled. Mt. Diablo Unified School District (“District”) contracts with a third party administrator (LWP) for the management of its claims.

What To Do If You Are Injured At Work (Employee)

Please note if you do not plan to open a workers’ comp claim and just need to make a report of injury check box #9 on the Employee Report of Injury form and do not complete a DWC1 form. You have one year to file a claim from the date of injury.

What To Do If Your Employee Is Injured At Work (Supervisor)

  • Once you have received notice of an employee injury provide the employee with the Employee Report of Injury form and  DWC 1  form to complete. The DWC 1 form is only completed if employee is opening a claim and is going to the doctor.
  • Explain to the employee that they have the right to file a Workers’ Comp Claim and receive medical care.
  • Give the employee the blue brochure entitled “Workers’ Compensation What To Do If You Are Injured at Work” for a list of our healthcare providers.
  • Complete the  Supervisor Report of Injury  form. If a DWC 1 form is completed by employee, the supervisor needs to complete questions #12, 13, 14 and sign the form.
  • Submit all forms as a PDF document immediately to or fax to 925-680-2505. Originals must follow via District pony mail.

Please contact Herbert Lester

925-682-8000 ext 4001




MDUSD strives to return injured/temporarily-disabled employee back to the workplace as soon as is medically appropriate. Our Early Return to Work Program (ERTW) provides our employees with the opportunity to return to work in a transitional work assignment while they recover. To learn more about the program click here.